Periodontal Treatment Available
- Full periodontal diagnosis, treatment and management.
- Gingival augmentation: Grafting procedures (free gingival grafts, connective tissue grafts) in conjunction with full thickness flap, split thickness flap, apically positioned flap, sandwich technique.
- Root coverage: Pedicle soft tissue graft procedures (lateral sliding flap, double papilla flap, coronally advanced flap for single or multiple recession defects, semilunar coronally advanced flap, tunnel technique, envelope technique) and free soft tissue graft procedures (epithelialised or subepithelial connective tissue graft usually taken from the palate).
- Mucosal defects corection around implants.
- Guided Tissue Regeneration procedures. Emdogain
- Crown lengthening procedures..
- Socket preservation procedure.
A 6-point pocket chart with a computerized recording (probe at 25g of pressure) and radiographs will be taken. Following this we provide a detailed written report, proposed treatment plan and estimate detailing the timescale and the cost of treatment.
We carry out a tooth by tooth assessment (the good, the bad, and the ugly) to decide which teeth should be extracted, which can be returned to health easily and finally those that are strategically important but will require expensive therapy to save them.
Initial Non-surgical Therapy
The aim is to stabilse the periodontal disease progression using a non-surgical approach:
- Patient motivation
- Explanation and instruction in patients home plaque control techniques.
- Root surface debridement: Removal of all supra- and sub-gingival plaque/calculus.
- Correction of additional plaque retentive factors: Removal of overhanging fillings & ill-fitting restoration margins where possible. (Liaise with patients dentist)
- Extraction of teeth that have a poor prognosis (liase with patients dentist)
- “Waterlase” Laser disinfection of the pockets
The aim of treatment is to achieve good marginal health and reduce the plaque and bleeding index below 20%.
At the Harman Dental Clinic we use state-of-the art ultasonic equipment with periodontal tips that access the deep periodontal pockets and furcations. We limit the use of hand instrumentation to specific areas with Gracey curettes to minimise trauma to the soft and hard tissues. This approach should help reduce post operative discomfort and the occurrence of tooth sensitivity after periodontal therapy. “Waterlase” desensitation has proved useful to seal open dentinal tubules.
Treatment of areas that fail to respond to initial non-surgical therapy
- Periodontal surgery: A range of different techniques are available including access flap, modified Widman flap, apically positioned flap, papilla preservation flap and distal wedge procedures.
- Regenerative periodontal therapy: Advanced periodontal disease therapy may lead to poor aesthetics in the anterior regions of the dentition. Treatment may include Emdogain Gel, synthetic membranes, synthetic or bovine derived graft materials, Composite bonding or a prosthetic gum slip.
- Treatment of furcation-involved teeth: Treatment options include: furcation-plasty, tunnel preparation, root separation and resection and regenerative periodontal surgery.
Excellent maintenance of post operative attachment levels were documented by numerous studies including Ramfjord 1973, Linde 1975 and Ramfjord 1982, .
The key to success is the attendance for recall visits at regular intervals (generally 3-4 months). At these recall intervals a continuous multilevel risk assessment in conjunction with the appropriate therapy will be carried out.
The following factors determine the patient’s risk assessment:
- Percentage of bleeding on probing
- Prevalence of residual pockets
- Number of teeth lost
- Loss of periodontal support in relation to the patient’s age
- Systemic and genetic conditions
- Environmental factors such as cigarette smoking
An assessment is made of the patients recall requirements based on the “spider web’ Lang & Tonetti 2003 Depending on the severity of the disease and the patient’s risk assessment we will offer long-term maintenance at the Harman Dental Clinic or with your General Dental Practitioner and Dental Hygienist.